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Background: Use of antiretroviral drugs (ART) has changed the epidemiology of HIV disease, making it a chronic illness and with many people developing long term sequelae of the disease such as hearing loss. This study compared hearing disorders, its types and severity among children with and without HIV disease.
Methods: This was a hospital based comparative cross-sectional study carried out among eligible patients who were HIV positive, aged 6 to 15 years recruited via systematic sampling method and matched by age and sex with HIV negative controls. An interviewer-administered questionnaire was used to extract the sociodemographic characteristics of the subjects, patients/caregivers awareness of hearing impairment and to document the otoscopic, Pure tone audiometry (PTA) and tympanometry findings performed on the patients. CD4 count was done for all the study participants while all HIV positive patients were graded for severity using WHO clinical Staging. Obtained data was analysed using the statistical package for social sciences (SPSS) version 22. A p-value of less than 0.05 was considered statistically significant.
Results: A total of 400 children aged 6 years to 15 years were recruited for the study out of which 200 were HIV positive (cases), while 200 were HIV negative (controls). Otitis media with effusion, otitis media and perforated tympanic membrane were the predominant tympanometry and otoscopic findings. Seventy-three (36.5%) of the HIV positive patients had hearing loss compared to 19(9.5%) of HIV negative patients and this was statistically significant (X2 = 41.1; p = 0.0001). Majority (95.9%) of persons with hearing loss had the conductive type and of mild degree 53 (72.6%). Only 3(4.1%) caregivers of the HIV positive children and 1 (5.6%) caregiver of the HIV negative children were aware of the hearing impairment in their children but none had complained to their primary health caregivers.
Conclusion: This study has established a higher rate of hearing loss, of the conductive type and of mild degree among HIV positive patient. It is necessary to assess and monitor the hearing in HIV positive children by conducting interval PTA testing and Tympanometry to ensure timely intervention since parental awareness is poor.
Lacovou E, Vlastarakos PV, Papacharalampous G, Kampessis G, Nikolopoulos TP. Diagnosis and treatment of HIV-associated manifestations in otolaryngology. Infect Dis Rep. 2012;4(1).
HIV/AIDS and STI Control Program. Guideline for management of pediatric HIV/AIDS. Royal Government of Bhutan. 2015;1-81.
Mahy M, Stover J, Stanecki K, Stoneburner R, Tassie JM. Estimating the impact of antiretroviral therapy: Regional and global estimates of life years gained among adults. Sex Transm Infec. 2010; 86(Suppl 2):67-71.
Bor J, Rosen S, Chimbindi N et al. Mass HIV treatment and sex disparities in life expectancy: Demographic surveillance in rural South Africa. PLos Med. 2015;12: e1001905.
Banks LM, Zuurmond M, Ferr R, Kuper H. The relationship between HIV and prevalence of disabilities in Sub Saharan Africa: A systematic review. Tropical Med Int Health. 2015;20:411-429.
Chandrasekhar SS, Connelly PE, Brahmbatt BS, Shah CS, Klaser PC, Baredes S. Otologic and audiological evaluation of Hummanimmunodefficiency virus infected patients. AmJ Otolaryngol. 2000;21:1-9.
Marra CM, Wechkin HA, Longstreth WD, Rees TS, Syapin CL, Gates GA. Hearing loss and anti retroviral therapy in patients infected with HIV-1. Arch Neurol. 1997;54: 407-410.
Birchall MA, Wight RG, French PD, Cockbain Z, Smith SJM. Auditory function in patients infected with the Human Immunedeficiency virus. Clin Otolaryngol. 1992;17:117-121.
Cohen BE, Durstenfeld A, Roehm PC. Viral causes of hearing loss: A review for hearing health professionals. Trens Hear. 2014;18:1-17.
Miziara ID, Weber R, Araujo FB, Pinheiro Neto CD. Otitis Media in Brazilian Humanimmunodeficiency virus infected children undergoing antiretroviral therapy. J Laryngol Otol. 2007;121:1048-1054.
Kohan D, Rothstein SG, Cohen NL. Otologic disease in patients with acquired immunodeficiency syndrome. Ann Otol Rhinol Laryngol. 1988;97:636-640.
Lee K, Tami T. Otolaryngologic. Manifestations of HIV. In: Coffey S, Volberding PA, Eds. HIV InSite Knowledge. San Francisco: UCSF. Center for HIV Information; 1998.
[Accessed on October 4, 2017]
Clark JG. Uses and abuses of hearing loss classification. Asha. 1981;23:493–500.
Kish L. Methods for design effects. J Off Stat. 1995;11:55.
Nukku D, Nyaiteera V, Llowet E, Nanseera D, Nakalema G , Westerberg B, et al. HIV Status and Hearing Loss Among Children between 6 and 12 years of age at a Large Urban Health Facility in South Western Uganda. Inter. J of Paed. Otorhino. 2017;101:172-177.
World Health Organization. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV -related disease in adults and children. Geneva. 2017;8-39.
Ensink RJ, Kuper H. Is Hearing Impairment Associated with HIV ? A Systematic Review of Data from Low and Middle income countries. Trop. Med. and Inter. Health. 2017;22:1493-1504.
Assuiti LF, Lanzoni GM, Santos FC, Erdmann AL, Meirelles BH. Hearing Loss in People With HIV/AIDS and associated factors: An integrative review. Braz. J. of Otorhinolaryngol. 2013;79(2):248-55.
van der Westhuizen Y, Swanepoel W, Heinze B, Hofmeyr LM. Auditory and otological manifestations in adults with HIV/AIDS. Int J Audiol. 2013;52(01):37–43.
Khoza K, Ross E. Auditory function in a group of adults infected with HIV/AIDS in Gauteng, South Africa. S Afr J Commun Disord. 2002;49:17–27.
Sooy CD, Gerberding JL, Kaplan MJ. The risk for otolaryngologists who treat patients with AIDS and AIDS virus infection: Report of an in-process study. Laryngoscope. 1987;97(04):430–434.
Hausler R, Vibert D, Koralnik IJ, Hirschel B. Neuro-otological manifestations in different stages of HIV infection. Acta Otolaryngol Suppl. 1991;481:515–521.
Pappas DG Jr, Chandra Sekhar HK, Lim J, Hillman DE. Ultrasructural ﬁndings in the cochlea of AID Scases. Am J Otol. 1994;15(04):456–465.
Buriti AK, Oliveira SH, Muniz LF, Soares MJ. Evaluation of Hearing Health in Children with HIV/ AIDS. Audiol. Commum. Res. 2014;19(2):105-11.
Hrapcak S, Kuper H, Bartlett P, Devendra A, Makawa A, Kim M,et al. Hearing Loss in HIV-Infected Children In Lilongwe, Malawi. PLoS ONE. 2016;11(8):e0161421.
Chao CK, Czechowicz JA, Messner AH, Alarcón J, Kolevic Roca L, Larragán Rodriguez MM, et al. High prevalence of hearing impairment in HIV-infected Peruvian children. Otolaryngol Head Neck Surg. 2012;146(2):259–65.
Matas CG, Santos Filha VA, Juan KR, Pinto FR, Gonçalves IC. Audiological manifestations in children and adults with AIDS. Pro Fono. 2010;22(3):269–74.
Torre P 3rd, Zeldow B, Hoffman HJ, Buchanan A, Siberry GK, Rice M, et al. Hearing loss in perinatally HIV-infected and HIV exposed but uninfected children and adolescents. Pediatr Infect Dis J. 2012;31(8):835–41.
Christopher N, Edward T, Sabrina BK, Agnes N. The prevalence of hearing impairment in the 6months 5years HIV/AIDS positive patients attending paediatric infectious disease clinic at Mulago Hospital. Int J Pediatr Otorhinolaryngol. 2013;77(2):262–5.
Govender R, Eley B, Walker K, Petersen R, Wilmshurst JM. Neurologic and neurobehavioral sequelae in children with human immunodeficiency virus (HIV-1) infection. J Child Neurol. 2011;26(11): 1355–64.
Matas CG, Iorio MC, Succi RC. Auditory disorders and acquisition of the ability to localize sound in children born to HIV-positive mothers. Braz J Infect Dis. 2008; 12(1):10–14.
Lasisi O. Otolaryngological manifestations of HIV/AIDS: A review. Ann Ib Postgrad Med. 2005;3:33.
Viswanatha B. Otolaryngologic manifestations of HIV infection. J Hematol Malig. 2012;2:33.
Taipale A, Pelkonen T, Taipale M, Roine I, Bernardino L, Peltola H, et al. Otorhinolaryngological findings and hearing in HIV-positive and HIV- negative children in a developing country. Eur Arch Otorhinolaryngol. 2011;268: 1527.
Alabi SB, Salami AK, Afolabi A, Dunmade D, Aremu SK, Olawunmi O, et al. Otolaryngologic Manifestations Among HIV/AIDS Patients in a Nigerian Tertiary Health Institution: An Update. Arquivos Int. Otorhinolaringol. 2010;14:398-403.
Fischel-Ghodsian N. Mitochondrial deafness mutations reviewed. Hum Mutat. 1999;13:261–270.
Zhao H, Young W, Yan Q, et al. Functional characterization of the mitochondrial 12S rRNA C1494T mutation associated with aminoglycoside-induced and non-syndromic hearing loss. Nucleic Acids Res. 2005;33:1132–1139.
Casano RAMS, Bykhovskaya Y, Johnson DF, et al. Hearing loss due to the mitochondrial A1555G mutation in Italian families. Am J Med Genet. 1998;79:388 391.
Casano RAMS, Johnson DF, Bykhovskaya Y, et al. Inherited susceptibility to aminoglycoside ototoxicity: Genetic heterogeneity and clinical implications. Am J Otolaryngol. 1999;20:151–156.
Pappas DG Jr, Chandra Sekhar HK, Lim J, Hillman DE. Ultrasructural ﬁndings in the cochlea of AIDS cases. Am J Otol. 1994;15(04):456–465.